Term-to-Perm Conversion Term-to-Perm Conversion with LTCSR
2,3
Term Conversion Plus
2
What forms or
documents are
required?
• Term Conversion application, AXA-
TCONV-2011 or state variation.
• Product Questionnaire (Section B), which
varies by type of product and state.
If underwriting is required:
• Term Rider Conversion and Purchase Option
Questionnaire (Section C), AXA-TCPO-2011 or
the state variation.
• Medical Information Questionnaire (Section C)
AXA-Med-2011 or state variation.
• New business application (Section A & D) AXA-Life-2011 (rev. 11/11) or
state variation.
• Product Questionnaire (Section B), which varies by type of
product and state.
• Term Rider Conversion and Purchase Option Questionnaire (Section C),
AXA-TCPO-2011 or the state variation.
• Accelerated DB for LTCSR Questionnaire Section C), (AXA-LTC-2012 or
the appropriate state variation) and any applicable state requirements.
• Medical Information Questionnaire (Section C) AXA-Med-2011
or state variation.
• HIPAA authorization form.
• New business application (Section A & D)
AXA-Life-2011 (rev. 11/11) or state variation.
• Product Questionnaire (Section B) which
varies by type of product and state.
• Term Rider Conversion and Purchase Option
Questionnaire (Section C), AXA-TCPO-2011 or
the state variation.
• Streamlined LTCSR Questionnaire (AXA-
LTC-2012 or the appropriate state variation)
and any applicable state requirements.
• HIPAA authorization form.
How is it
submitted?
• eApp or paper application. • eApp or paper application. • Paper application.
For financial professional use only. Not for use with, or distribution to, the general public.
For more information, please call the Life Insurance Sales Desk or visit equitableLIFT.com/termseries.
© 2024 Equitable Holdings, Inc. All rights reserved. IU-6623323.1 (5/24) (Exp. 5/26) | G2592750 | Cat. #159615 (5/24)
1 The term policy face amount after a partial term conversion must meet the minimum face amount requirement.
Equitable may change its conversion rules regarding plan, age and class of risk at any time. Additional rules
may apply if the policy is converted while on an active Disability Premium Waiver claim.
2 This program is not a contractual right. Equitable will periodically review results and may discontinue the
program at any time.
3 In California, this rider is called the Comprehensive Long-Term Care Rider. In Florida, this rider is called the
Long-Term Care Insurance Rider.
4 LTCSR is not available with Corporate Owned Incentive Life
®
(COIL) or Interest Sensitive Whole Life
SM
(ISWL).
5 The Term-to-Perm Conversion information provided is for the currently sold term series. For older products,
refer to the specific policy, product guide or the marketing material titled “Equitable offers attractive term
conversion products” for further detail.
Life insurance products are issued by Equitable Financial Life Insurance Company (Equitable Financial) (NY, NY)
or Equitable Financial Life Insurance Company of America (Equitable America) and co-distributed by affiliates
Equitable Network, LLC (Equitable Network Insurance Agency of California in CA; Equitable Network Insurance
Agency of Utah in UT; Equitable Network of Puerto Rico, Inc. in PR) and Equitable Distributors, LLC. Variable life
insurance products are co-distributed by Equitable Advisors, LLC (Equitable Financial Advisors in MI & TN) and
Equitable Distributors, LLC. For New York state-based (i.e., domiciled) Equitable Advisors Financial Professionals,
life insurance products are issued by Equitable Financial Life Insurance Company (NY, NY). All companies are
affiliated and directly or indirectly owned by Equitable Holdings, Inc., and do not provide tax or legal advice.
Term Series products are issued by Equitable Financial Life Insurance Company (Equitable Financial) (NY, NY) and are
co-distributed by Equitable Network, LLC (Equitable Network Insurance Agency of California, LLC in CA; Equitable
Network Insurance Agency of Utah in UT; and Equitable Network of Puerto Rico, Inc. in PR) and Equitable Distributors, LLC.
TermOne
®
is a registered service mark of Equitable Financial Life Insurance Company. TermOne
®
is issued by
Equitable Financial Life Insurance Company in all jurisdictions. TermOne
®
is also issued in all jurisdictions by
Equitable Financial Life Insurance Company of America in all jurisdictions except NY and PR.
A life insurance policy is backed solely by the claims-paying ability of the issuing life insurance company. It is not
backed by the broker/dealer or insurance agency through which the life insurance policy is purchased or by any
affiliates of those entities, and none makes any representations or guarantees regarding the claims-paying ability
of the issuing life insurance company.
References to Equitable in this brochure represent both Equitable Financial Life Insurance Company and Equitable
Financial Life Insurance Company of America, which are affiliated companies. Overall, Equitable is the brand name
of the retirement and protection subsidiaries of Equitable Holdings, Inc., including Equitable Financial Life Insurance
Company (Equitable Financial) (NY, NY); Equitable Financial Life Insurance Company of America, an AZ stock
company with an administrative office located in Charlotte, NC; and Equitable Distributors, LLC. Equitable Advisors is
the brand name of Equitable Advisors, LLC (member FINRA, SIPC) (Equitable Financial Advisors in MI & TN). The
obligations of Equitable Financial and Equitable America are backed solely by their claims-paying abilities.
Life Insurance: • Is Not a Deposit of Any Bank • Is Not FDIC Insured • Is Not Insured by Any Federal Government Agency • Is Not Guaranteed by Any Bank or Savings Association • Variable Life Insurance May Go Down in Value